title: Promoting thrombolysis in acute ischemic stroke.
abstract: OBJECTIVE
  Thrombolysis with intravenous recombinant tissue plasminogen activator is an effective treatment for acute ischemic stroke, but the number of treatable patients is limited. The PRomoting ACute Thrombolysis in Ischemic StrokE (PRACTISE) trial evaluated the effectiveness of a multidimensional implementation strategy for thrombolysis with intravenous recombinant tissue plasminogen activator in acute ischemic stroke.
  
  
  METHODS
  The PRACTISE trial was a national multicenter cluster-randomized controlled trial with randomization after pairwise matching. Twelve hospitals, both urban and community, academic and nonacademic, in the Netherlands participated. All patients admitted with stroke within 24 hours from onset of symptoms were registered. The intervention included 5 implementation meetings based on the Breakthrough Series model. The primary outcome was treatment with thrombolysis. Secondary outcomes were admission within 4 hours after onset of symptoms, death or disability at 3 months, and quality of life.
  
  
  RESULTS
  Overall 5515 patients were included in the study' 308 patients (12.2%) in the control centers and 393 patients (13.1%) in the intervention centers were treated with thrombolysis (adjusted OR, 1.25; 95% CI, 0.93 to 1.68). Among the 1657 patients with ischemic stroke admitted within 4 hours from onset, 391 (44.5%) of 880 in the intervention centers were treated with thrombolysis and 305 (39.3%) of 777 in the control centers; the adjusted OR for treatment with thrombolysis was 1.58 (95% CI, 1.11 to 2.27).
  
  
  CONCLUSIONS
  An intensive implementation strategy increases the proportion of patients with acute stroke treated with thrombolysis in real-life settings. An apparently pivotal factor in the improvement of the treatment rate is better application of contraindications for thrombolysis.
authors.affiliation: Erasmus MC University Hospital Rotterdam, Department of Neurology, and Institute for Health Policy and Management, Erasmus University Rotterdam, Room H-673, PO Box 2040, 3000 CA Rotterdam, the Netherlands. m.dirks@erasmusmc.nl
authors.forename: Maaike
authors.initials: M
authors.lastname: Dirks
authors.forename: Louis W
authors.initials: LW
authors.lastname: Niessen
authors.forename: Jeroen D H
authors.initials: JD
authors.lastname: van Wijngaarden
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Cees L
authors.initials: CL
authors.lastname: Franke
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.forename: Robbert
authors.initials: R
authors.lastname: Huijsman
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.forename: Mirella M N
authors.initials: MM
authors.lastname: Minkman
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator